Prostate cancer screening can be easy to put off or overlook. For Prostate Cancer Awareness Month, Curtis Chastain, MD, director of FMOL Health | Our Lady of the Lake Physician Group Men’s Health and Executive Wellness Center, explains why men should talk with their doctors about screening and how the people in their lives can help start the conversation.
Prostate cancer screening is one of those health conversations that can easily fall through the cracks.
Men may put it off because they feel fine, aren’t sure when screening should begin or simply haven’t thought to ask their doctor about it.
That’s why this is a conversation men need to have with their doctors and one the people in their lives can help encourage.
If you’re a man in your 40s or 50s, now is the time to start asking your doctor about prostate cancer screening. And if you’re a wife, partner, family member or friend, you may be the person who reminds him to have that conversation. A simple question about a PSA test could help make sure an important screening doesn’t get overlooked.
Here’s why that conversation matters.
The Numbers He’s Not Thinking About
Prostate cancer is the second leading cause of cancer death among men, behind only lung cancer. One in eight men will be diagnosed with it in his lifetime. And the risk isn’t evenly distributed; it rises with age. It’s higher in African American men, and it’s higher in men with a father or brother who had it.
The good news, and it’s really good news: caught early, prostate cancer has one of the highest cure rates of any cancer. Caught late, it’s a very different conversation. That gap between “early” and “late” is almost entirely a function of whether a man got screened.
“I Don’t Want a Finger in My Rear End”
Let’s name the fear directly, because it’s the actual reason a lot of men skip this. For decades, prostate screening meant a digital rectal exam, and that memory, or that rumor passed between guys who’ve never actually had one, is enough to keep men out of the office.
Here’s what he needs to know: the first step is a blood test.
The PSA (Prostate-Specific Antigen) test is a simple blood draw, usually done as part of an annual physical, right alongside cholesterol and blood sugar. No exam required to get started. If the PSA result raises a question, then further evaluation — sometimes an exam, sometimes an MRI, sometimes a referral — becomes part of the conversation. But the door opens with a blood draw, not a physical exam.
That one fact solves the objection for a surprising number of men.
Who Should Be Screened, and By Whom
The honest answer is: this should be a conversation, not a rule everyone follows the same way, which is exactly why it needs to happen with a doctor who actually knows him.
- Most men should start talking about PSA screening with their primary care physician in their 40s, earlier if there’s a family history of prostate cancer or if he’s African American, a group with a higher lifetime risk.
- His PCP is the right doctor to start with. Not a specialist, not a walk-in clinic — his own primary care doctor, who knows his baseline health, his family history, and can track his PSA over time rather than react to a single number in isolation.
- The number matters less than the trend. A PSA can bounce for reasons that have nothing to do with cancer like infection, inflammation, even lab variation. A physician who knows a patient’s history can tell the difference between normal noise and a genuine warning sign. That’s the value of a real relationship with a primary care doctor, rather than a one-time reading with no context behind it.
PSA screening has had a complicated reputation over the years. For a stretch, an abnormal result led straight to a biopsy, no questions asked — and a lot of those biopsies turned out to be false alarms. That led some guidelines to pull back on screening altogether. But the answer was never “stop testing.” It was “test smarter, with a doctor who knows the patient.” A rising PSA in the context of a stable five-year baseline means something entirely different than the same number showing up out of nowhere. That kind of judgment only happens with continuity of care.
“But What If It’s Positive?”
This is usually the real fear underneath the reluctance. It’s not the blood draw, but what happens after it. So, let’s answer it, because knowing the answer tends to make men more willing to get screened in the first place, not less.
If a PSA leads to a biopsy and the biopsy finds cancer, the next question isn’t just “cancer or not,” it’s how aggressive it is. Pathologists measure that with something called a Gleason score, and it helps to think of it like a dog breed. Not every prostate cancer behaves the same way. A low Gleason score behaves like a poodle; unlikely to ever threaten his life. A high Gleason score behaves more like a pit bull; something that needs to be dealt with. Most cases fall somewhere in between, and the right doctor will walk him through exactly where his falls and what it means for someone his age and health.
That score, combined with his age and overall health, points toward one of a few paths: surgery, radiation, or careful monitoring. None of those decisions need to be made in a panic, and none of them need to be made alone. A good urologist sits down and works through it step by step.
The point isn’t to make this sound simple. It’s to make it sound survivable because for most men, caught early, it is.
What This Looks Like in Real Life
Men who get this right rarely have a dramatic story to tell; that’s the point. A PSA test gets added to routine labs. The number gets tracked year over year. And if something changes, it gets caught early enough that the outcome is surgery and recovery, not a late-stage diagnosis.
Men who get this wrong usually have a common story: nobody ever asked. A previous doctor decided that low risk meant no test was necessary. A decade went by. And when the cancer was finally found, it had already spread beyond the point where “early” was still an option.
The difference between those two stories isn’t luck. It’s whether a man had a doctor who offered the test and whether he said “yes.”
What You Can Actually Do About This
You don’t need to become an expert to move this forward. If you’re a man, start by asking your doctor a simple question:
“When should I have a PSA test?”
And if there’s a man in your life who may be due for screening, encourage him to ask:
“When’s the last time you talked to your doctor about a PSA test? It’s just a blood draw. Can we get that on the calendar?”
If he doesn’t have a primary care physician, that’s the actual first step: finding a doctor he’ll actually see regularly. A screening test only works if someone is there year after year to notice when a number changes.
Prostate cancer is remarkably treatable when it’s found early. That starts with making sure screening doesn’t become the health conversation that gets overlooked.
